Meet the CIPHER grantees

Rebecca Hodes

Year awarded: 2013
Institution: University of Cape Town, South Africa
Research site: Mzantsi Wakho study sites, Eastern Cape, South Africa
Primary mentor: Lucie Cluver, Department of Social Policy and Intervention, Barnett House, UK

Rebecca Hodes is Director of the AIDS and Society Research Unit, University of Cape Town. She is a medical historian, and co-principal investigator of the Mzantsi Wakho study about health among teenagers in South Africa.

More information on Rebecca | Email

“As lead authors on South Africa’s National Adolescent and Youth Health Policy, we drew principally on our research, co-funded by CIPHER, to ensure that the policy was based on cautious, authentic and empirical participatory research with teenagers.”

Research project: Promoting adolescent antiretroviral adherence and sexual and reproductive health uptake in South Africa: How can health and social protection services collaborate programmatically with adolescents living with HIV?

The issue

Southern Africa is home to 1.2 million adolescents living with HIV, whose long-term health outcomes depend on strict adherence to ART. The little existing research on adolescent ART-users in Africa shows low adherence rates and poor access to sexual and reproductive health (SRH) services. Adolescence is a time of increased risk taking, and teenagers living with HIV are an especially vulnerable and challenging group for service providers. However, their initiation into and retention in ART and SRH programmes is under-investigated. HIV- adolescents living with HIV have rarely been included as partners in the design and operationalization of HIV and SRH services.

The CIPHER project

CIPHER funded the baseline phase of Mzantsi Wakho (“Your South Africa” in Xhosa), which is the largest known mixed-methods, community-based study on ART adherence and sexual health among adolescents. The study used qualitative and quantitative methods to achieve two key aims:

  • Identify and investigate risk and resilience-promoting factors for ART adherence and access to SRH services among teenagers living with HIV through linked qualitative and quantitative studies
  • Collaborate with adolescents living with HIV, healthcare and social service providers to design support tools to improve adolescent ART adherence and SRH service uptake.

The study was planned in collaboration with adolescents living with HIV, UNICEF, the South African government, NGOs and CBOs. It offered an unprecedented opportunity to bring the experiences of youth into the policy arena.

The impact

The study had a direct capacity-building aim. It included a principal investigator who gained further research skills through mentorship, three PhD students and two other students. In 2014/5, the project also employed more than 30 people in the Eastern Cape, one of South Africa’s most economically depressed provinces.

Mzantsi Wakho developed a policy engagement plan, which detailed how to maximize the impact of its research findings and how to facilitate the uptake of these findings by policy makers locally, nationally, regionally and globally.

Indeed, there has been a direct impact on policy. UNFPA and the South African Department of Health asked Dr Hodes’ team to provide technical support to review and rewrite the National Adolescent and Youth Health Policy in 2015. The team commissioned rapid evidence reviews on topics identified by adolescents and other experts as the most crucial in health promotion, and then convened consultations and workshops with adolescents, caregivers, policy makers and health authorities to seek input on drafts of the policy. Policy engagement at district, local, national and global levels continues.